Provider Demographics
NPI:1245238229
Name:KAISER, JOHN B (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:KAISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 MILL ROAD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2012
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1601 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02724-2107
Practice Address - Country:US
Practice Address - Phone:508-678-0004
Practice Address - Fax:508-678-6970
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2012-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA38090208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2032651Medicaid
MAK0830101Medicare PIN
B75268Medicare UPIN
MA2032651Medicaid